PROGRAM FOR LEADERSHIP DEVELOPMENT APPLICATION FOR ADMISSION PLEASE SPECIFY SESSION DATE: Please answer all questions. This application must be fully completed and signed, and the Sponsoring Statement must be received, before review by the Admissions Committee. Please have your sponsoring executive complete the enclosed Sponsoring Statement. This document may be sent directly from the sponsoring official to the Admissions Committee or, if appropriate, may be sent together with the application. This is a writeable PDF. You may type directly on this form, or print it and complete it by hand. Please type or print legibly. I certify that all the information and accompanying material provided in connection with this application are authentic and accurate. SIGNATURE OF APPLICANT: DATE: NOTE: You must use Acrobat Reader 9.0 or higher to complete, save, and send this form electronically. GENERAL INFORMATION NAME: NICKNAME/FAMILIAR NAME FOR NAME BADGE: MALE FEMALE COUNTRY OF CITIZENSHIP: TITLE OR POSITION: COMPANY/ORGANIZATION NAME: DATE OF BIRTH: DIVISION (if applicable): Month/Day/Year COMPANY/ORGANIZATION ADDRESS: (P.O. boxes accepted outside U.S.) Street City State/Country Zip Code/Postal Code COMPANY/ORGANIZATION TELEPHONE: COMPANY/ORGANIZATION WEBSITE: FAX: ULTIMATE PARENT COMPANY: YOUR HOME ADDRESS: HOME TELEPHONE: Street City State/Country Zip Code/Postal Code MOBILE TELEPHONE: PREFERRED MAILING ADDRESS: BUSINESS ADDRESS HOME ADDRESS LANGUAGE PROFICIENCY Proficiency in spoken and written English is essential for active participation in the fast-moving classes and small group discussions. If English is your second language, or if you have less than one year s experience working in an English-speaking environment, please provide a brief statement documenting your proficiency. (The Admissions Committee also may require an interview.) PLEASE RETURN THIS APPLICATION: ONLINE: Applications may be submitted online at: www.exed.hbs.edu Applications may be submitted via email to: exed_admissions@hbs.edu BY MAIL: ADMISSIONS COMMITTEE Program for Leadership Development Harvard Business School Soldiers Field Boston, MA 02163-9986 U.S. BY FAX: ADMISSIONS COMMITTEE Program for Leadership Development Fax: +1-617-496-1731 For questions on the status of your submitted application, please email exed_admissions@hbs.edu or call +1-617-495-6226. 6160
CONFIDENTIAL: The information you provide below is for use by the Admissions Committee only. ORGANIZATION YOUR ULTIMATE PARENT COMPANY YOUR COMPANY/DIVISION Products/Services: Annual Sales Volume $,,, (in U.S. dollars): $,,, Number of Employees: How many employees are under your direct supervision? How many reporting levels are above you, including the chief executive officer of the parent company? What is the title of the person to whom you report? Please describe your organizational hierarchy or provide an organizational chart. PLEASE CHECK YOUR CURRENT INDUSTRY (check one only): Agriculture Apparel Banking Biotechnology Chemicals Communications Construction Consulting Education Electronics Energy Engineering Entertainment Environmental Finance Food & Beverage Government Health Care Hospitality Insurance Machinery Manufacturing Media Not-For-Profit Recreation Retail Shipping Technology Telecommunications Transportation Utilities Other specify: WHAT FUNCTION BEST DESCRIBES YOUR POSITION? (check one only): Accounting/Control Logistics Engineering Manufacturing/Operations Finance Marketing Fundraising Medicine General Management Planning Human Resources Product Development Information Services Project Management Law Public Relations Purchasing Religion Research & Development Sales Teaching Other specify: ANNUAL COMPENSATION (INCLUDING BONUS) IN U.S. DOLLARS (check one only): <$100,000 $151,000 $200,000 $101,000 $150,000 $201,000 $300,000 $301,000 $500,000 >$500,000
WORK EXPERIENCE Please list your positions in reverse chronological order, starting with your current one. If all positions are in the same company, please give the major promotional sequence. NAME OF COMPANY TITLE OR POSITION FROM Month/Year TO Month/Year PLEASE ESTIMATE YOUR TOTAL YEARS OF PROFESSIONAL EXPERIENCE: Please continue your responses on the back cover or attach a separate statement if necessary. PLEASE PROVIDE A BRIEF DESCRIPTION OF YOUR ORGANIZATION AND/OR BUSINESS UNIT. PLEASE DESCRIBE YOUR CURRENT RESPONSIBILITIES, INCLUDING YOUR LEVEL IN THE ORGANIZATION. WHAT OBJECTIVES DO YOU HOPE TO ACHIEVE BY ATTENDING THIS PROGRAM? WHAT DO YOU ANTICIPATE YOUR CAREER PROGRESSION WILL BE WITHIN YOUR COMPANY IN THE NEXT FIVE YEARS? HOW WOULD YOU CHARACTERIZE YOUR LEADERSHIP STRENGTHS AND WEAKNESSES? PROVIDE EXAMPLES AS APPROPRIATE. WHAT ARE THE MOST FORMIDABLE CHALLENGES FACING YOUR ORGANIZATION AND/OR BUSINESS UNIT?
EDUCATION DEGREE (check only High School Two-Year College BS/BA MS/MA MBA Harvard MBA highest level attained): JD/Law PhD MD Foreign Diploma Other UNIVERSITY: YEAR: HAVE YOU ATTENDED OTHER HARVARD BUSINESS SCHOOL PROGRAMS? PROGRAM NAME DATE Please indicate, by putting an X in the appropriate box, the amount of prior experience and familiarity you have with each of the following areas or activities. STRONG MODERATE LITTLE OR NONE Major job responsibility Working familiarity Unfamiliar and/or formal academic training General Management: Accounting and Control: Marketing: Finance and Financial Analysis: Human Resource Management: Production or Operations: Information Technology: Other Expertise (please describe): HOW DID YOU LEARN ABOUT THIS PROGRAM? Direct mail package HBS Executive Education website Online advertisement Social media HBS email notification Internet search Print advertisement Other (specify): WHAT FACTOR HAD THE MOST INFLUENCE ON YOUR DECISION TO APPLY TO THIS PROGRAM? A previous participant in an HBS Executive Education program Participant Name Program/Year HBS Executive Education Corporate Relations An MBA graduate of HBS Division Head or Manager HBS faculty Human resource department Other (specify): IF YOU SAW A PRINT ADVERTISEMENT, PLEASE SPECIFY WHERE: Financial Times Harvard Business Review HBS Alumni Bulletin MIT Sloan Management Review strategy+business Other (specify): IF YOU SAW AN ONLINE ADVERTISEMENT, PLEASE SPECIFY WHERE: Bloomberg Businessweek Business Insider CNN Harvard Business Review LinkedIn MarketWatch MIT Sloan Management Review The New York Times Quartz strategy+business The Wall Street Journal Women s Leadership Exchange Other (specify):
CANCELLATION POLICY Payment is due within 30 days of the invoice date. Cancellations or deferrals must be submitted in writing more than 30 days before the program start date to receive a full refund. Due to program demand and the volume of preprogram preparation, cancellations or deferrals received 14 to 30 days before the program start date are subject to a fee of one-half of the program fee. Requests received within 14 days of the program start date are subject to full payment of the program fee. Upon acceptance, payment is required prior to the program start date. I have read the cancellation policy and agree to the terms stated. (please initial here) SPONSORING INFORMATION Harvard Business School Executive Education requires that a senior executive within the organization sponsor the applicant. (Please note that the sponsor must be someone other than the applicant.) Your application must be accompanied by a Sponsoring Statement. SPONSORING COMPANY/ORGANIZATION NAME: NAME: TITLE OR POSITION: BILLING INFORMATION An invoice will be emailed to the individual indicated below. NAME: TITLE OR POSITION: COMPANY/ORGANIZATION NAME: COMPANY/ORGANIZATION ADDRESS: (P.O. boxes accepted outside U.S.) Street City State/Country Zip Code/Postal Code TELEPHONE: FAX: In accordance with Harvard University policy, Harvard Business School does not discriminate against any person on the basis of race, color, sex or sexual orientation, gender identity, religion, age, national or ethnic origin, political beliefs, veteran status, or disability in admission to, access to, treatment in, or employment in its programs and activities. Harvard may disclose, without consent, directory information about students. However, under the Family Educational Rights and Privacy Act (FERPA) participants may request that the school not disclose directory information about them. Your FERPA rights are available at: http://www.security.harvard.edu/enterprise-security-policy/3-student-info/policies-3_1. Please contact Enrollment and Admissions Services at exed_admissions@hbs.edu, if you have concerns or wish to discuss your rights under FERPA. September-15
PROGRAM FOR LEADERSHIP DEVELOPMENT SPONSORING STATEMENT This is a writeable PDF. You may type directly on this form, or print it and complete it by hand. Please type or print legibly. I certify that all the information and accompanying material provided in connection with this application are authentic and accurate. SIGNATURE OF SPONSORING OFFICIAL: DATE: NOTE: You must use Acrobat Reader 9.0 or higher to complete, save, and send this form electronically. NAME OF APPLICANT: COMPANY/ORGANIZATION NAME: SESSION DATE: This statement should be completed by a senior executive of the organization who is thoroughly familiar with the candidate and can provide a detailed, firsthand appraisal. The sponsoring employer certifies that the employee is an employee in good standing, that the employer has approved the employee s participation in the program, and that the employer will notify HBS if there is any material change in the employee s status prior to the program. To be eligible for attendance, the candidate must be a full-time employee of the sponsoring company throughout the entire session of the Program for Leadership Development, and agree to return full-time to the sponsoring organization in a managerial role upon completion of the program. It is understood that participants will be completely free of official duties while members of the program, and that they will not be asked to be absent from the program except for emergencies. Please have your sponsoring executive complete this Sponsoring Statement. This document may be sent directly from the sponsoring official to the Admissions Committee or, if appropriate, may be sent together with the application. The candidate s application will not be reviewed until both the application and Sponsoring Statement have been received. In accordance with Harvard University policy, Harvard Business School does not discriminate against any person on the basis of race, color, sex or sexual orientation, gender identity, religion, age, national or ethnic origin, political beliefs, veteran status, or disability in admission to, access to, treatment in, or employment in its programs and activities. Federal or state law may require that all admissions material be shown to a student upon request. Harvard may disclose, without consent, directory information about students. However, under the Family Educational Rights and Privacy Act (FERPA) participants may request that the school not disclose directory information about them. Your FERPA rights are available at: http://www.security.harvard.edu/enterprise-security-policy/3-student-info/policies-3_1. Please contact Enrollment and Admissions Services at exed_admissions@hbs.edu, if you have concerns or wish to discuss your rights under FERPA. NAME OF SPONSORING OFFICIAL: TITLE OR POSITION: SPONSORING COMPANY/ORGANIZATION NAME: COMPANY/ORGANIZATION ADDRESS: (P.O. boxes accepted outside U.S.) Street City State/Country Zip Code/Postal Code COMPANY/ORGANIZATION TELEPHONE: COMPANY/ORGANIZATION WEBSITE: FAX: 6160
CONFIDENTIAL: The information you provide below is for use by the Admissions Committee only. PLEASE DESCRIBE THE CURRENT RESPONSIBILITIES OF THE APPLICANT WITHIN THE ORGANIZATION. NUMBER OF REPORTING LEVELS ABOVE THE APPLICANT, UP TO AND INCLUDING THE CHIEF EXECUTIVE OFFICER OF THE PARENT COMPANY: PLEASE PROVIDE AN ORGANIZATIONAL CHART. HOW DOES THE COMPANY IDENTIFY AND EVALUATE HIGH-POTENTIAL INDIVIDUALS? WHAT COMPANY PROCESSES OR PROGRAMS ARE IN PLACE TO DEVELOP THESE INDIVIDUALS? HOW MANY OF THESE INDIVIDUALS HAS THE COMPANY IDENTIFIED AT THIS TIME?
PLEASE DESCRIBE YOUR OBJECTIVES IN NOMINATING THE APPLICANT FOR THE PROGRAM FOR LEADERSHIP DEVELOPMENT. WHAT DISTINGUISHES THE APPLICANT FROM OTHER HIGH-POTENTIAL INDIVIDUALS? WHAT PROSPECTIVE CHANGES ARE PLANNED IN THE APPLICANT S POSITION AND/OR RESPONSIBILITIES UPON COMPLETION OF THE PROGRAM? WHAT, IF ANY, LONG-RANGE ORGANIZATIONAL LEADERSHIP OBJECTIVES HAVE BEEN IDENTIFIED FOR THE APPLICANT AT THIS TIME? HAVE YOU DISCUSSED THESE OBJECTIVES WITH THE APPLICANT? YES NO HOW WOULD YOU EVALUATE THE APPLICANT S STRENGTHS, AS WELL AS AREAS FOR DEVELOPMENT? CONSIDER SUCH FACTORS AS KNOWLEDGE OF FINANCE, HUMAN RELATIONS, MARKETING, AND LEADERSHIP. HOME-BASED MODULES I AND III OF THE PROGRAM FOR LEADERSHIP DEVELOPMENT REQUIRE AN AVERAGE COMMITMENT OF 10 TO 12 HOURS PER WEEK. IS THE COMPANY WILLING TO SUPPORT THIS TIME COMMITMENT DURING THE COURSE OF THE PROGRAM? YES NO
LANGUAGE PROFICIENCY Proficiency in spoken and written English is essential for active participation in the fast-moving classes and small group discussions. If English is the applicant s second language, or if he or she has less than one year s experience working in an English-speaking environment, please provide a brief statement documenting his or her proficiency. (The Admissions Committee also may request an interview.) CANCELLATION POLICY Payment is due within 30 days of the invoice date. Cancellations or deferrals must be submitted in writing more than 30 days before the program start date to receive a full refund. Due to program demand and the volume of preprogram preparation, cancellations or deferrals received 14 to 30 days before the program start date are subject to a fee of one-half of the program fee. Requests received within 14 days of the program start date are subject to full payment of the program fee. Upon acceptance, payment is required prior to the program start date. I have read the cancellation policy and agree to the terms stated. (please initial here) PLEASE RETURN THIS SPONSORING STATEMENT: ONLINE: Applications may be submitted online at: www.exed.hbs.edu Applications may be submitted via email to: exed_admissions@hbs.edu BY MAIL: ADMISSIONS COMMITTEE Program for Leadership Development Harvard Business School Soldiers Field Boston, MA 02163-9986 U.S. BY FAX: ADMISSIONS COMMITTEE Program for Leadership Development Fax: +1-617-496-1731 For questions on the status of your submitted sponsoring statement, please email exed_admissions@hbs.edu or call +1-617-495-6226. September-15